Doctors Can’t Stay Silent Anymore: Why Shoshana Ungerleider Is Calling on Clinicians to Speak Out

Dr. Shoshana Ungerleider has built a career at the intersection of science and storytelling without ever leaving medicine behind. As an internal medicine physician, founder of the End Well Foundation, host of the TED Health podcast, and producer of Emmy and Oscar nominated documentaries, she’s made it her mission to help people talk more honestly about health, illness, and the end of life. Whether she’s breaking down chronic pain bias or challenging media myths about CPR, her work is reshaping how clinicians show up for their patients and for the public.

On this episode of How I Doctor, Dr. Graham Walker talks with Shoshana about the one skill most doctors were never trained in - communication. They dig into what it takes to build trust in a world flooded with hype, how to stay grounded when patients believe misinformation, and why more physicians need to speak up - not just in the exam room, but on social media, on camera, and in public life. If you’ve ever felt unprepared for the emotional side of medicine or unsure how to respond when patients bring in beliefs from TikTok instead of textbooks, this conversation is a must-listen.

In a healthcare system flooded with hype, misinformation, and systemic blind spots, Shoshana offers a timely reminder that how we communicate is just as important as what we know. In this episode, she and Dr. Graham Walker explore what it means for physicians to speak out, confront bias, and build public trust starting at the bedside and extending far beyond it.

Why Doctors Must Lean Into Uncertainty to Rebuild Trust

“I think the public really is smart enough to handle nuance, but I think we need to come at this with honesty about uncertainty, and I try to focus on stories that help people understand their bodies better and have better conversations with their doctors rather than promising some kind of miracle outcome.”

As health misinformation floods social media and hype often drowns out evidence, Shoshana argues that physicians can’t afford to oversimplify—or stay silent. Communicating complexity with honesty, she says, is what builds long-term trust. Her framework starts with the science and ends with the question: “Would I want my own family hearing this?”

How Storytelling Can Shift Culture Around Death and Dying

“There is an appetite for this kind of content out there… and shining light in some of these hidden, darker places, especially as it relates to end of life, is such a wonderful way for educating the public so that they can understand what goes on in hospitals and hopefully be able to make better decisions for themselves and the people they love when it matters.”

Shoshana didn’t plan to become a filmmaker—but her work on Extremis helped show the power of narrative to make end-of-life conversations more visible, humane, and actionable. Through TED, Netflix, and now End Well, she’s helping shift the way Americans think about palliative care, CPR, and what it means to die with dignity.

How Clinical Bias Shows Up—And What to Do About It

“The question of self-checking for bias is crucial, and I think the most important tool maybe is simply pausing and asking yourself, what assumptions am I making about this person right now?”

Even with years of experience, Shoshana discovered through death doula training that unconscious bias and emotional triggers were still shaping her clinical behavior. She advocates for practical tools like “the switch test” and reflective practices to help physicians recognize and interrupt bias at the bedside.

Why More Physicians Need to Speak Out

“I think we actually have to, as much as I hate to say that… we cannot be silent.”

From navigating prior auths to confronting public health misinformation, Shoshana says the time for physicians to stay silent is over. Whether it’s political advocacy, media engagement, or simply sharing daily realities, doctors have a responsibility to be part of the public conversation.

Dr. Shoshana Ungerleider reminds us that being a great physician today requires more than clinical expertise—it takes curiosity, courage, and a willingness to communicate when it matters most. Whether you’re facing misinformation, breaking bad news, or simply trying to connect with your patients on a human level, this episode is a call to show up—not just as a doctor, but as a leader, a listener, and a voice for change.

Find out more about Shoshana here and connect with her on Instagram at https://www.instagram.com/shoshanamd/

Listen to the TED Health Podcast at https://www.ted.com/pages/ted-health

To make sure you don’t miss an episode of How I Doctor, subscribe to the show wherever you listen to podcasts. You can also read the full transcript of the episode below.

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Transcript

Dr. Shoshana Ungerleider:
I was reading a story yesterday, a headline about somebody talking about a correlation that just didn't make any sense. And so I think it's hard for us, certainly as physicians with the scientific training that we've had to even recognize that somebody would make that jump. And then to be kind and empathetic and really share in a way that doesn't make someone feel bad, that they don't understand something that they should or be condescending about it. That's always the hardest thing for me.
And so I often try to think about, "Well, maybe how would I describe this to my niece and nephew?" Who are young, they're in elementary school.

Dr. Graham Walker:

Welcome to How I Doctor, where we're bringing joy back to medicine.
Today, I'm joined by Dr. Shoshana Ungerleider, a practicing internal medicine physician at Crossover Health, host and producer of the TED Health podcast, and founder of the nonprofit Endwell, which focuses on transforming the end of life experience through film, media, and conversation. Shoshana has executive produced, award nominated Netflix documentaries that I love, that use storytelling to reshape clinician mindsets and the culture around dying with dignity.
I'm so excited to talk to Shoshana today because of her mastery of science and healthcare communication. In a time when misinformation threatens public trust in clinicians and clinicians are navigating burnout and bias and rapid technology and workload change, her work I think shows us how physicians can use media and narrative not just to catch up with the change, but to lead it.
Dr. Shoshana Ungerleider, welcome to How I Doctor, thank you for being here.

SU:
Graham, thank you so much for having me. That was such a kind introduction. I'm honored to get to talk with you today.

GW:Fully deserved. Shoshana, maybe we'll just start talking about your communication. There is so much misinformation and then less misinformation, but just hype out there. How are you deciding what is worth digging in deeper and deciding, "Yeah, this is worth me learning more about"?

SU:

Why Physicians Must Communicate Uncertainty in Medicine

This is something I think about constantly because I think the line between education and hype can seem razor thin. And I couldn't agree more that the rampant misinformation out there is really threatening the health of society.
I think my approach is probably pretty methodical. I try to start with the science. Sometimes I don't get to have a say always, especially with TED on exactly what we're covering in terms of a topic. But I'm asking the question, is there peer-reviewed research? Are the studies well designed? Are the researchers credible? And then I ask the harder question, what does this mean for people right now? Take psychedelics as you mentioned, there's genuinely exciting research happening around psilocybin in the context of major depression, existential distress in a palliative care setting for dying patients.
But I'm really careful to emphasize that we're talking about controlled therapeutic settings with trained professionals in a clinical environment, not recreational use. I always try to include the limitations, the unknowns, the what we don't know yet parts. I think the public really is smart enough to handle nuance, but I think we need to come at this with honesty about uncertainty. And I try to focus on stories that help people understand their bodies better and have better conversations with their doctors rather than promising some kind of miracle outcome. And I think the test I try to use is, would I want my own family members to hear this information?

GW:That's great. Yeah.

SU:
And if the answer is yes and it's backed by solid science, then it's probably worth sharing.

GW:I love the way you said the public can handle nuance, but I think it's so critical that we mention it, that we communicate that. I think the easier answer, obviously, always in medicine is, definitely do this, definitely don't do that. Always this, never that. But we know as doctors there's almost nothing in medicine that is that obvious and straightforward. So I think that's such a critical point that we have to mention it and make it clear that, hey, this is promising. But the idea that something works in a clinical trial is often so different than how it works unfortunately in the real world with way more complex elements.

SU:

The Public Can Handle Nuance—If Doctors Explain It Well

I think what I have learned over these years of doing more public facing science communication is that people are really hungry for health information, but they're also overwhelmed by maybe conflicting messages, especially in this moment in time. My philosophy is to lean into the uncertainty rather than shy away from it. And I even in the early days of the pandemic found myself saying, because it was absolutely the truth, "Here's what we know, here's what we don't know. Here's what the research suggests that might be true." And I think people really appreciate that honesty. I think it's actually necessary and we need to be training clinicians in how to communicate uncertainty because it's not something that we're typically as comfortable with.
And then further, I try to give people their own tools, I think, to become better consumers of health information, so not just passive recipients. Again, the pandemic taught us that scientific literacy isn't a luxury, it's a necessity for making good decisions about our health and our families and our communities. And so I always try to connect the science to the human experience. I think data without context is just noise for the general public. And I think when you can help someone understand how a clinical trial might affect their conversation with their doctor, or how maybe a new treatment might impact their family's decisions about vaccines, I think that's when science becomes really meaningful for people.

GW:

Doctors vs. Influencers: Why Physicians Are Held to a Higher Standard

The thing that feels frustrating to me as a doctor trying to combat misinformation and provide good information online for other people is that I think we are appropriately held to a higher standard. We have medical training, so the expectation is that a physician is going to give a more nuanced, maybe slightly less excited version of communication, but people who have no medical training and who may have a financial incentive and often do have a financial incentive to sell their new probiotic or their new magnesium supplement or something like that, there's no expectation that someone else isn't lying to you online. But people would be very upset and think that there are major ethical violations if a doctor were to do that. And so I think that's the other thing that's really challenging today is doctors are held to a different standard.

SU:
I couldn't agree more. And so much of what I end up doing on TED Health, with my own family members in my day-to-day conversations with an Uber driver is trying to debunk the myths that are out there. And so it's with so much content, information available to people all hours of the day and night in every possible way coming at all of us, what do we do about that? It is so tricky. I certainly don't have an answer. But I think the more that we as physicians, as scientists can be talking about that, can be encouraging people to learn how to evaluate information for themselves, certainly teaching that to young kids in school, I mean, that starts way, way, upstream and probably need to be doing a much better job of the scientific literacy piece for young people. But it's so, so, so hard.

GW:Yeah. I mean, even just basic correlation versus causation is such a critical thing for human beings to understand and comprehend. And to have that ability, to have that ... I mean, I think of that as one of the fundamental things that I always go to when I read a study or read a headline. It's like, "Oh, well, okay. Is it possible that this is just a correlation?" And I don't think many or probably most people think in that particular way.

SU:

Debunking Health Myths with Empathy, Not Condescension

No, it's huge. I was reading a story yesterday, a headline about somebody talking about a correlation that just didn't make any sense. And so I think it's hard for us certainly as physicians with the scientific training that we've had to even recognize that somebody would make that jump. And then to be kind and empathetic and really share in a way that doesn't make someone feel bad, that they don't understand something that they should or be condescending about it, that's always the hardest thing for me.
And so I often try to think about, "Well, maybe how would I describe this to my niece and nephew?" Who are young, they're in elementary school, in a way such that they could really understand. I'd be curious to hear when you see patients, how you address that with folks?

GW:So I liked your concept of imagining it's your niece or your nephew. I mean, I was going to say my mom.

SU:
And my mom for sure.

GW:Sorry, Mom, that I get really frustrated when you ask me tech questions, so maybe that's not the best example.
I think I always try to remind myself, get curious, not furious. And, "Oh, it's interesting that you think that. I would never have thought that in a million years. Tell me more. Let's see the question behind the question is what I try to do. I'm sure I'm not always perfectly successful.

SU:
Yeah, curious, not furious. I love that. Can I use that?

GW:It's all yours.
Moving from news segments and podcasts and film, how have your strategies shifted when you're trying to tell a message or a story through different mediums? Whether it's the podcast or it's some of your documentaries, which are outstanding. I mean, truly incredible the way they were able to communicate what I feel on the physician side for a patient who is maybe nearing the end of their life. How do you decide what strategies to employ in various mediums?

SU:
I don't know that I always have been as proactive and well-thought-out as maybe ... I got into a lot of this media work really by accident. So I can certainly speak to the particular questions, but I just want to put it out there that I thought I was going to be a full-time clinician, a hospitalist doing mostly taking care of folks in the hospital. And then really these opportunities came to me in really unexpected ways, I guess I would say.

GW:Where did they come from, Shoshana? Maybe tell us that story.

SU:

From ICU to Netflix: How Endwell Sparked a Media Career

Early on in my training, I got really interested in how we care for folks facing serious illness and the end of life and I was really lucky to have wonderful mentors in palliative medicine where I trained. And while I knew I didn't want to be a palliative care physician, I knew that I wanted to shift first how medical education is taught or at least think through how can we make sure that all trainees get a core competence in communication skills and palliative medicine fundamentals.
I started thinking more broadly about what would it take to shift the cultural conversation since so much of the reticence to engage with end of life comes from kind of the societal taboos? And there's so many reasons for that. And then certainly the perverse incentives in medicine that encourage us to always do more to patients as opposed to stopping and asking what does this human being in front of me most value with the time they have left? And how can I best treat them in a way that matches what they hope to have in terms of living their life?
So I started thinking and talking to folks doing this work. And it just so happened that a colleague of mine, Jessica Zitter, who's an ICU doc and palliative medicine physician in Oakland, California, was filming a documentary in her ICU extremis and got involved with that project really by accident over coffee. Jessica and I were talking about the project and she said, "Oh, I know you're interested in the broader conversation in society about end of life. And I've always felt like the ICU is the place where so many of these conversations are so concentrated and emotions are so heightened and the medicine is so complex that wouldn't be wonderful if people could see what takes place in an ICU? Not only from the patient and family perspective, but also the conversations that clinicians are having about care for seriously ill people." And so got involved with that one.
And then we were super lucky in that Netflix decided to start buying short documentaries that year. And then it was premiered at Tribeca, won Tribeca, and then I was like, "Whoa, there's something here." I have no background in film, zero. I like romantic comedies, okay? Documentaries is not something that was ever on my radar. And then it was on me for an Academy Award, which showed me that, wow, there is an appetite for this kind of content out there. And shining light in some of these hidden darker places, especially as it relates to end of life, is such a wonderful way for educating the public so that they can understand what goes on in hospitals, and hopefully be able to make better decisions for themselves and the people they love when it matters.

Film, Podcasts, and News: Different Strategies for Different Mediums

So to get back to your original question, I think the other work that I've gotten into with podcasting and television, each medium I think requires a very different approach. News segments are about clarity, being concise and urgency. You literally have two minutes to make one clear point that's going to stick with viewers. There's not much room for nuance, so you have to be very disciplined about what you're trying to accomplish. I think usually it's about getting people to think about one specific thing and why it matters to them.
I think with podcasts, as you know, depending on the length, you have more luxury of complexity and you can tell a longer story, and I think that's where I've really tried to dig into more of the systemic issues in medicine.
And then film is different altogether. I think film can in a beautiful way bypass the kind of intellectual defenses that people have about difficult topics. And so I think that emotional connection is what creates, well, hopefully lasting change in how people think about some of these issues. The key thing I've learned is that you can't just take the same message and put it into different formats. I think you have to think about what each medium does best and then craft an approach accordingly.

GW:It really reminds me that everything that we are trying to do is around impact, and I think the physician version of that is outcome. Just doing this podcast and learning about marketing and doing things for off call, I've been really impressed at how much broader the world is outside of medicine. I mean, I think as a physician, I think I have a weird, it's kind of like a know it all, like, "Oh, I've got all this." And then you step outside of it, whether it's a podcast or a documentary or anything else, and you realize, "Oh my gosh, there's so much else out there that can help me make an impact, or help me take better care of my patients, or have better outcomes as well that isn't in the house of medicine specifically."

SU:
Absolutely, yes. I think there is a whole massive, somewhat scary world out there of things going on, and it's a lot to learn. I mean, I think early on when I was thinking about how do we change medical education and think differently about caring for people at end of life, I went to a bunch of conferences in the world of hospice and palliative medicine, and I met incredible people doing groundbreaking work, and they'd been doing it for decades. But we did a lot of preaching to the choir.
I think that academic publications are incredibly important, people doing the research, it absolutely has to happen. I mean, that's at the core. To me, it's about broadening our spheres of influence, trying to, especially as it relates to changing the conversation around end of life so that more people can get care that's aligned with their goals and their values, and educating the public about what palliative care is. For example, we must think much more broadly than beyond the walls of our hospital, our clinic, or beyond the readers of academic journals. I think to me, it's really, really important to think about the bigger conversations that are happening out there. But it's certainly tricky because we tend to like to be head down or we don't have time to not do that and stay in our lanes. And I have just not done that.

GW:It reminds me of a couple studies that are related to end of life and palliative care that probably need to be repeated now. But I think one study looked at the outcomes of CPR on television. I think from the shows ER in the '90s, and 95% of people get CPR, survive. And then I think there was another study that looked at, well, what does it mean if someone's on a ventilator and a lot of people thought, "Oh, you can still talk on a ventilator. You can still interact with your family, you can walk around, blah, blah, blah."
And I think it is such an important point that people in healthcare, or especially people that work in a hospital, whether it's physicians or nurses or social workers, we have a very specific understanding of what it means to get CPR, or what full code means, or what being on a ventilator means. And then extract that out and we have hundreds or thousands of opinions from the general public about what that means. The range of understanding is so critical that I often think that physicians are talking way over here about something, and then you've got what the patient actually is receiving or understands is way over here and it's an entirely different understanding. They're literally not even talking, saying the same words and having the same definitions.

SU:

Why Accurate Portrayals of End-of-Life Care on TV Matter

Yes. Couldn't agree with you more. And actually, Graham, Endwell a couple of years ago started looking at how do television portrayals of end of life, whether it be CPR ventilators, conversations about hospice and palliative care, influence viewers of TV shows. And so we did a study, a script analysis looking back 10 years, so not all the way back to the early days of ER, even though I love that show, in terms of how those topics were discussed. And then looking forward, how can we work with TV writers to make sure that they're ... Well, to encourage them, let's say, to be more accurate with their portrayals of things like CPR, of not just showing acute violent death being the predominant thing on television, even though that's maybe what people want.

GW:Yeah, dramatic and exciting.

SU:
Exactly. And to show more balanced conversations for people on the medical shows. For example, how The Pit has done such a beautiful job. We were lucky enough to get to help influence some of that work that they highlighted around in the ER, like the pause. So when somebody dies, they take a moment to recognize that life, or the more nuanced conversations about advanced directives. And that show just did such an incredible job of that. I don't know if you agree? But I think that so many people of varying ages throughout their lives are primed with information that they get from television. And so how can we, again, encourage more accurate storylines so that people can really be armed with the right information at the right time when they need it to be able to make the best decisions for their loved ones and themselves?

GW:

I think the power of media is, it helps maybe people reframe or have a different understanding about a particular topic or idea. I am sure both of us have had scenarios where we might not agree with a patient's decisions, whether it's about end of life or treatment or anything like that. And sometimes you start to butt heads and you realize, "This doesn't seem to be going anywhere. This has stopped being a productive conversation."
But I think media has a way of subtly getting in there, and maybe I'm not able to change my patient's opinion about a tetanus vaccine or something like that today, but you could imagine a podcast, a piece of art, an episode from The Pit, something could make them just kind of question things because their defenses are maybe down a little bit more when they're being exposed to that.

SU:

Why Physicians Must Step Into the Political Arena

Yeah. I think media is certainly one tool. Although, now that I've been reading much more about misinformation, especially in this moment in time and thinking about how do we educate folks and maybe change minds about things that are incredibly important for public health? I think certainly what they're seeing on TV, how we're communicating with patients I think from the top down in terms of our political leaders and policy decisions are incredibly important.
I know that you're somebody who has had politicians or conversations about what it looks like to have physicians in these positions. I also agree that's incredibly important. I think the pandemic really showed us how crucial it is to have physicians who can communicate effectively with the public, when you have political leaders who understand both the science and the human impact of policy decisions. We're seeing that play out in a big way. So I am concerned about what's going on in this country, but I'm hopeful that it will encourage more of our colleagues to get involved in the political arena, if they can.

GW:Yeah, I think we're seeing that. I think we're seeing people running for Congress. Dr. Tina Shah is an intensivist in New Jersey. I think also just having more physicians speaking out. Traditionally, medicine is not a place where we publicly broadcast our opinions about things. And we've had Dr. Elizabeth Potter who spoke out about how she was treated by United Healthcare, and so I think we're seeing more people just sharing what is a prior off? What does your doctor actually have to do to get Zofran approved for somebody with cancer? I mean, it's crazy. But I think that's such a positive way to look at things right now is this is actually encouraging more of our colleagues to speak out about what it's like to practice medicine today.

SU:
Yeah. I mean, I think we actually have to, as much as I hate to say that.

GW:Yeah. It's like a requirement now. Yeah,

SU:
Yeah. We cannot be silent..

GW:We can't take it for granted.

SU:
Yeah. No, absolutely.

GW:Shoshana, given your coverage of chronic pain bias on TED Health, what prompts or tips might you recommend for clinicians to check in during their clinical encounters?

SU:

Checking Bias at the Bedside: Tools for Clinicians

The question of self-checking for bias is crucial. And I think the most important tool maybe is simply pausing and asking yourself, "What assumptions am I making about this person right now?" And it's wild to kind of sit with what comes up for all of us. I try to use something like what I call the switch test, meaning if this exact same patient was a different gender or different race or age, would I be responding in the same way? Would I be as likely to believe their pain maybe if that's coming up? Or would I be as quick to offer certain treatments? So I think that that's a helpful tool.
And then I also think noticing body language and tone. Are you maintaining good eye contact? Are you sitting down or standing up with this patient? Are you rushing through this interaction? What's triggering you to do that?
It's interesting. Well, it's interesting to me. You might think this is crazy, but I earlier in the year did a death doula certification course. And it's not because I'm planning to practice necessarily as a death doula who is a nonmedical person for patients and families facing the end of life, I thought that doing a course would help me better understand the process and the work. But I was blown away by how much I got out of the coursework that was really focused on bias and recognizing where my triggers are in life. Because we all, even though we-

GW:What? I don't have any triggers. I don't know what you're talking about,

SU:
Right? I know. Well, we don't. I mean, at least I didn't in medical school think about how my own personal upbringing maybe, or my own personal journey affects the way that I care for patients and show up for people. I was recognizing that I was getting uncomfortable or feeling pain in my neck or a racing heart rate, and I was like, "What is going on here? What is triggering me about this conversation?"
And it really got me to do some interesting inner work that I never in a million years thought I needed. Or I really assumed that I had that piece sorted out because, of course, I can stay objective. I've cared for people who are dying hundreds, thousands of times, and it's not an issue for me. And it turns out we all bring our own stuff to every encounter. And in thinking about how we can best show up for our patients and their families. I think that's actually a really important thing to be looking at.

GW:One of the things that I think is really important is that physicians are able to let our patients know that we are human beings and we bring our personality, we bring our perspectives and our flaws to the table when we are taking care of patients as well.
I think one of the key points there is that these are skills that we have to hone and get better at is looking at our bias, how to communicate with people with serious illness. Just like I would never just tell the med student, "Oh, yeah, can you go drop a central line in room seven?" It's a skill just like any other procedure that we do. We have to learn and train and get better at these things. These things are not automatic, just like a central line is not automatic, intubation is automatic. All of these things are things that we can get better at. Growth mindset, we can improve upon over time and training and taking a course.

SU:

Why Communication Training Should Be as Essential as Procedures

Again, I was super lucky, I know I mentioned this before, to have wonderful mentors in palliative care, in my ICU rotations, on the medicine wards, and really got to see just how life changing a skilled, thoughtful conversation with a family can be. But that is not something that I think even now is widely considered to be important and valued as part of medical education and I think that really has to shift.
I mean, it's been now about eight years, but I know a JAMA survey looked at what practicing physicians reported in terms of their training in how to break bad news and how to talk about difficult subjects. And 70%, seven-zero percent, of practicing physicians said they had had no training in it. And we do our patients and their families such a disservice by not having that skillset. Again, this is not just for primary docs or people in the ER on the front lines. This is for subspecialists too, because so much of our system is fragmented into these specialty places where it's going to be the job of the medical oncologists, say, or even the nephrologist to be bringing up palliative care potentially, or talking about prognosis. And I think it's incredibly important that we not only value it as a healthcare system and reimburse adequately for it, but then also just as human beings see that communication is really just incredibly central to our work as healers and doing the best job we can for our patients.

GW:And Shoshana, I would add that so much of medicine now is management of chronic disease and so it's not curative anymore. And so we all have to be able to talk with patients and communicate, "Hey, you have this condition that this is not something that I'm going to be able to cure. We're going to be managing it and trying to stabilize it and maybe suppress it and prove it, but there's going to be blips along the road where you're going to have an exacerbation of it. But ultimately this thing that you have, whether it's COPD or heart failure or depression, is something that we are going to work together on, but it's not something that I'm going to be able to prescribe a medicine or do a procedure and resolve this permanently." And so we have to be able to communicate and set the expectations clearly for our patients that way as well.

SU:
There's this assumption with modern medicine that we can solve anything with a pill or a procedure. And while it is true for many things, and I'm so grateful for that, for much of chronic illness it's not that way. And so I think it's, again, incredibly important that we communicate that, we get to know our patients and be thoughtful about asking questions like, "What matters most to you in your life? What trade-offs are you willing to make for a chance to get better?" If in fact that question comes up.

GW:Maybe tell me what's the most common maybe misconception you come across, whether it's working with Endwell or palliative care and hospice? What's the most common misconception that maybe patients bring to the table that you have to maybe undo or educate them on?

SU:

I think people conflate hospice in palliative medicine all the time, even physicians sometimes. And of course, hospice is a type of palliative medicine, but palliative medicine is an entire team-based specialty of medical care that focuses on quality of life for people facing serious illness, and of course their families and caregivers. And focuses on things like symptom management, but also the psychosocial stuff. And that's the emotional pieces around care, existential distress around dying, spiritual connection that is important to many, many patients.
And in fact, the data show, the earlier that patients get referred to palliative care, the longer they live, which is somewhat counterintuitive, the better outcomes they have overall, and better patient and family satisfaction. And even better clinician satisfaction around the care that they're providing. So I think that's really important. And hospice being a Medicare designation, really, for care that is for patients who are most likely within six months of the end of their lives, and you typically have to give up curative treatment in order to go on hospice and just focus on quality of life and symptom management.

What Most Families Don’t Realize About Hospice Care

Just as important, I think people have an idea, this idea that hospice is a place you go and that it's 24/7 care. Turns out the majority of hospice, I would say 90-plus percent is not a place that you go. It's provided in a home or in a nursing facility by family members and loved ones who are not trained in how to care for medically-complex people. We don't do the best job of communicating that to patients, to families and caregivers in terms of what the expectations are. You maybe get a few phone calls with the hospice nurse if something comes up.
I cared for my dad when he was dying of stage-four pancreatic cancer, and I was shocked at how ill equipped I was to provide hospice care to my own father. I was texting my friends who were hospice nurses being like, "Us this normal? Should I give more medicine? What do I do here?" And I've been doing this work for a very long time. I think that if it's hard for me as a doctor-

GW:Exactly.

SU:
... I cannot imagine what this is like for people who don't have any medical training.

GW:

Shoshana, if you had 30 seconds to deliver a TikTok to every clinician, everybody that sees patients about death and dying, dying well, end of life, what do you think you would tell them?

SU:
I think certainly we can't be good at talking about this with our patients. And frankly, I would go as far as to say be good doctors if we haven't thought about it for ourselves. So think about your own relationship to mortality first. Think about the experiences you've had in your own life with death and dying. What scared you? And I think that can be really helpful and go a long way in terms of how you approach it with your patients. And hopefully that means sitting down and talking to them human to human about who they are. And again, this idea of what matters most to you? And how can I as your doctor help provide you with the best possible care for however long you have left on this Earth?

GW:Well, Shoshana, it's an incredible skill that I think, like you said, is highly underrated for a clinician, a social worker, anybody who is able to help communicate that to a patient. It is often a big frustration when you can tell you're maybe just not seeing eye to eye with a patient or a family about something. And it's also such an incredible feeling when the social worker walks into the room and is able to have that conversation.

SU:

The Undervalued Role of Social Workers in End-of-Life Care

I can't even tell you how much I have learned from my social work colleagues. And often that's in the realm of palliative medicine, that social workers are part of that team and such a huge part of the team. I think where we can, leaning on our colleagues in social work knowing that they're incredibly busy too. But how can we learn from each other? How can we lead with curiosity with patience and empathy? It goes such a long way. It's certainly not easy, but so, so important.

GW:Yeah. Well, Dr. Shoshana Ungerleider, it has been an absolute pleasure. Thank you so much for talking with me today.

SU:
Oh my gosh, Graham, thank you. Likewise. This was such an interesting conversation and really was delighted to get to speak to you today.

GW:Thank you.
Thanks for joining me today. For interviews with physicians creating meaningful change, check out offcall.com/podcast. You can find How I Doctor on Apple, Spotify, or wherever you listen to podcasts. We'll have new episodes weekly.
This has been and continues to be dr. Graham Walker. Stay well stay inspired and practice with purpose.